Does Statin Therapy Reduce the Risks of Mortality and Major Adverse Cardiac and Cerebrovascular Events in Young Adults with End-Stage Renal Disease? Population-Based Cohort Study.

Ya-Lien Cheng,Chung-Ying Tsai,Chao-Yu Chen,Chao-Yi Wu,Ya-Chung Tian,Hsiang-Hao Hsu,Huang-Yu Yang,Ching-Chung Hsiao,Chieh-Li Yen

doi:10.3390/jcm10102097

Abstract

Among hemodialysis patients aged more than 40 years old, previous large-scale studies showed statin treatment had no effect on reducing cardiovascular adverse events. However, young-adult-onset end-stage renal disease (ESRD) patients have different physicosocial factors compared to older ESRD patients. The benefit of statins in such a specific group has not been well evaluated. Through the use of Taiwan’s National Health Insurance Research Database (NHIRD), young adult patients aged 20–40 with incident ESRD requiring permanent dialysis between 1 January 2003 and 31 December 2015 were identified. The enrollees were further divided into two groups depending on whether they received statin therapy for more than 90 days (statin group) or never received any statin (nonstatin group) in the first year after initiation of dialysis. Propensity score weighting (PSW) was used to balance the baseline characteristics between the two groups. After PSW, the statin group (n = 771) exhibited a higher rate of major adverse cardiac and cerebrovascular events (MACCEs) (2.65% vs. 1.44%, hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.43–2.45), and acute myocardial infarction (1.51% vs. 0.30%, HR: 5.34, 95% CI: 3.40–8.39) compared to the nonstatin group (n = 1709). The risk of all-cause mortality, cardiovascular (CV) death. and stroke did not significantly differ between the two groups. Similar to older patients, this study demonstrated that statin therapy cannot offer any protective effects in reducing CV outcomes among young adult ESRD patients undergoing dialysis.

Highlights

Considerable research has confirmed that statins can considerably reduce the incidence of major adverse cardiovascular events and risk of mortality in high-risk patients, such as those with hyperlipidemia and diabetes [1,2,3,4,5]
Several large-scale randomized controlled trials on statin treatment [6,7,8] and high-quality meta-analyses [9] have reported that statin treatment did not provide significant CV protective effects in patients with end-stage renal disease (ESRD) as they did in traditional high-risk groups despite their marked low-density lipoprotein (LDL)-cholesterol-lowering ability
CV mortality among the ESRD population has been primarily attributed to nonatherosclerosis CV events, such as arterial calcification due to hyperphosphatemia and hypercalcemia and left ventricular hypertrophy (LVH) due to poor fluid control after dialysis initiation

Summary

Introduction

Considerable research has confirmed that statins can considerably reduce the incidence of major adverse cardiovascular events and risk of mortality in high-risk patients, such as those with hyperlipidemia and diabetes [1,2,3,4,5]. Several large-scale randomized controlled trials on statin treatment [6,7,8] and high-quality meta-analyses [9] have reported that statin treatment did not provide significant CV protective effects in patients with end-stage renal disease (ESRD) as they did in traditional high-risk groups despite their marked LDL-cholesterol-lowering ability. This lack of CV benefit has been attributed to long-term comorbidities, such as diabetic vasculopathy and hyperlipidemia in early chronic kidney disease (CKD).

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